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Comment by caymanjim | Hacker News Reader

The kind of people who are giving the author PTSD aren't going to be helped by free housing, free money, or free anything other than free medical care, and in the extreme cases, institutionalization.

Since we find the idea of involuntarily committing psychiatric patients to be unpalatable these days, we have to either way until they commit a serious crime and go to prison, or live with them on our streets and in our libraries.

There are many homeless people who are not socially problematic, but that's not what this article is about. The problem people are incompatible with free housing, because they are violently unstable. They're schizophrenic, drug-dependent, or just plain violent.

All these responses about economic considerations or a lack of homeless support infrastructure are totally missing the real issue, which is that some people have such extreme mental illness or other social problem that they are incompatible with peaceful society, and it's not something than can be solved with housing and cash. That is a separate problem entirely.

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>Since we find the idea of involuntarily committing psychiatric patients to be unpalatable these days

We closed the asylums, because the long-term detention of the mentally ill is costly and inhumane. We can do better than just warehousing people in pseudo-prisons. We completely failed to provide adequate support in the community for people with severe and enduring mental illness, which is why so many people are trapped in a cycle of homelessness and incarceration.

Most of these people aren't "incompatible with peaceful society", they just need help and can't get it. If any one factor is to blame, it's the systematic defunding of social work and community mental health. If your local library is full of mentally ill homeless people, the fundamental questions are why do these people have nowhere else to go? and why is nobody here who actually has the training to help these people?.

In complete agreement. Consider also the historical uniqueness of public libraries: if they didn't already exist in the fabric of civic life, would we really have the political ability to build them? We have little imagination or desire to build civic institutions any more; we only know how to build commercial ones.

It's not just civic institutions. Manhattan would be illegal to build these days in Manhattan.

I'm glad that incapacity hasn't affected the whole world, yet. But it's seems to be spreading.

>Manhattan would be illegal to build these days in Manhattan

I don't really view that particularly to be a problem. Manhattan was already built in Manhattan, it doesn't need to be built there again. Now that it exists, it needs to be managed with the new problems that have arisen since the building of Manhattan. Problems change when you scale, things that were not a problem when you were growing are now a problem after you achieve massive success

"Do things that don't scale" is great advice for a growing startup, and for a very good reason. Because once you get to Manhattan size, you have to start doing things that do scale. If Manhattan hadn't changed its building codes, it would be unlivable today.

Nobody is really talking about building codes. Building a skyscraper without fire sprinklers is a bad idea, but requiring fire sprinklers is not a thing that prevents you from building skyscrapers. On the other hand, a rule restricting building height or imposing minimum parking requirements or the like does exactly that, and has no benefit other than to enrich the existing landlords when it prevents housing supply from responding to increased demand.

Probably not. It would be easy to paint public libraries as "socialist" which is a dirty word nowadays.

There was a window of time (roughly from the eighties until about 2016) when "socialist" wouldn't be used because it was perceived as outdated, too linked with the Cold War and Red Scare... so it would be painted as "entitlement" or "lack of personal responsibility": if you wanted to read, you should have bought your own damn books.

(I think the discourse is being revamped in light of the rise of democratic socialism in US politics)

> Most of these people aren't "incompatible with peaceful society", they just need help and can't get it

Do you have any source that most of these people can't get it? With a father who outright refused any medical help unless basically forced on him, in a country where it's completely free, I can absolutely relate to the argument that not having involuntary psychatric treatment plays a big part here. And his mental state was only a minor part of his health issues.

It's not nice to be in stationary psychatric treatment. These are horrible places you want to leave as soon as possible. But it sometimes can't be helped.

I can even relate to the point that it's better for (some/most of) these people to live on the streets than in a psychatric facility, while it's probably worse for society as a whole.

There's a world of difference between "having access to medical care" and "having access to appropriate care for a disorder that presents particular obstacles in accessing conventional care pathways". Access to care in the US is highly inconsistent, because there's a patchwork of providers and funders.

Effective care for people with severe and enduring mental illness needs to be patient-led but assertive - we're not going to lock you up unless it's genuinely in your best interests, but we're not going to let you slip through the cracks either. Compulsory inpatient treatment is a necessary last resort where people pose a clear and immediate risk, but it should not be the basis of care for severe and enduring mental illness.

The issues regarding involuntary treatment in the US are highly complex, but the evidence indicates that involuntary community treatment does not make a significant difference in clinical outcomes. Forcing people to attend appointments or take medication doesn't seem to result in any long-term benefit on aggregate. Some people do benefit (at least in the short term) from being treated against their will, but compulsion undermines the relationship of trust between care providers and service users and discourages people from engaging with care.

https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8...

https://en.wikipedia.org/wiki/Assertive_community_treatment

https://www.cochrane.org/CD004408/SCHIZ_compulsory-community...

> significant difference in clinical outcomes

But by removing these peiple from the streets nd the libraries, even if they are not cured themselves, we avoid a librarian -- a productive member of society -- from developing PTSD.

My (controversial?) opinion is that the civil commitment laws aren't good enough. A (mentally ill) person shouldn't have to become a danger to others or themselves before a serious conversation about involuntary commitment can be had.

And I acknowledge and fully accept that this is a very rough position to hold today. But, it is born out of over a decade of direct personal experience. It's come from watching the state of California continually fail to provide adequate support to my clinically diagnosed family member, to our family as people who care about this person, as well as failing to protect to public from him time and time again.

but we're also conveniently shielded from having to come up with actual good and humane solutions to the problems these people have. I don't think the benefits are worth the cost.

We have a long history of simply 'hiding' people who were inconvenient and/or problematic, where in many cases various forms of treatment have essentially solved the problem.

I personally remember a time where kids with AD(H)D were sent to 'special schools', lumped together with others who often had more severe problems, for example. I definitely think things got a bit better now that we found ways to keep these kids integrated in society.

I've known quite a few people who were suicidal who had a hard time getting care.

One 30-something women who was on medicaid, suicidal, history of opioid addiction and (I believe, based on her living with us for 1.5 years and my reading everything I could about psychiatric diagnosis) schizoaffective showed up at the hospital and got discharged 48 hours later.

She killed herself a month after that. She was unable to work, even unable to get up in the morning and smoke a cig sometimes even though she was addicted to tobacco.

A 50-something man I knew drank antifreeze, presented at the ER. Was discharged 48 hours later. His family wondered where he was in that time. People in the ER don't take suicide attempts seriously because they have a few "frequent fliers" who take a handful of pills every week.

He gets a referral to a psychiatrist two weeks later. Has to fill out his name and birthday 20 times, gets asked questions like that over and over again, has an argument with a nurse, is underwhelmed with the doctor... That night we get a call from his wife and they don't know where he is. We told her to call the police, she did, they kicked down the door to the garage and found he was hanging.

There are a lot of conditions for which we don't have good answers. If you have something the world doesn't know how to fix, the reality is you aren't getting the help you need even in a good system. In the US, this gets compounded by systemic issues.

> adequate support in the community for people with severe and enduring mental illness, which is why so many people are trapped in a cycle of homelessness and incarceration.

The level of "adequate support" needed for (some of) those people are much higher than what you're probably imagining

> they just need help and can't get it

And even when they get one day they just say "I'm not taking the meds anymore" and then what? It's back on the streets or homeless hostels.

Sure, they might not be aggressive per se, but that doesn't mean they are "compatible" with society.

> the fundamental questions are why do these people have nowhere else to go? and why is nobody here who actually has the training to help these people?

You're just pointing out problems without pointing up the solutions. And I'm afraid the best solution would be something much similar to what's described in your 1st paragraph.

>And even when they get one day they just say "I'm not taking the meds anymore" and then what? It's back on the streets or homeless hostels.

If someone goes off their meds, you don't just abandon them to the streets. You send a trained mental health nurse and/or social worker to talk to them, several times a day if necessary. If they don't want to engage, you work with them to build a relationship of trust. You work with that person to get them back on a suitable course of medication, or to help them manage their symptoms and manage their life while unmedicated. You provide supported housing and supported employment or work-related activity wherever it would prove beneficial. You keep working with them again and again and again unless you're damned certain that they're truly beyond help.

Of course that's expensive, but it's also remarkably good value for money compared to the alternative. The net difference between a borderline functional person and a completely dysfunctional person can exceed a million dollars per year in policing, incarceration, ER visits and other costs.

This model of community care isn't new and it's proven to work and to be cost effective. There are plenty of places in the world that don't rely on mass institutionalisation and have remarkably low rates of homelessness.

> You send a trained mental health nurse and/or social worker to talk to them, several times a day if necessary. If they don't want to engage, you work with them to build a relationship of trust. You work with that person to get them back on a suitable course of medication, or to help them manage their symptoms and manage their life while unmedicated.

Serious question, would you be willing to do that job? For what price? For how long?

It is exactly what happens in most countries here in Europe

It already exists, you don't have to invent it.

If I were a trained mental health professional who had also been trained on emotional regulation capable of doing this job in a society where mental health professionals are equal to nurses and doctors I would definitely do this job for the salary equivalent to a nurse or a doctor. I’d be contributing to the greater good much more than my current position writing software that will never change/save lives.

You make it sound like those professionals have some magical training to withstand the abuse, the stress, the bad situations of the job.

While they do have some training, it is not possible to shake some things off easily and it does get old quick. One of the reasons why drug abuse is so prevalent in some medical communities.

The median physician salary is $217,000, and the average family doctor oversees a panel of 2,300 people, who see him or her about 20 minutes, two or three times a year.

There is not a sustainable system where workers pay taxes sufficient to afford a specially trained nurse or doctor for full time, personal care for everyone who could benefit from it.

If we don’t have social networks that shoulder burdens at what looks like an economic loss, there’s not enough paid care to go around at the levels of empathy we want.

The 2300 number is commonly cited, but more recent surveys suggest average panel size is much lower.

Recent studies of various practice settings in the United States and abroad found current panel sizes ranging from 1200 to 1900 patients per physician. For example, Kaiser Permanente reported a mean per-physician panel size of 1751 patients, and Group Health Cooperative of Puget Sound reported a panel size of 1490 patients per physician.18 The US Department of Veterans Affairs reported a mean panel size of 1266 patients per full-time equivalent physician.19 One study in Canada found a panel size of 1400 patients per PCP.20 A study in Denmark found a maximum level of 1600 patients per physician,21 and a study in England found 2033 patients per solo physician.22

https://www.jabfm.org/content/29/4/496.full

You seem to imply that I'm proposing something new and radical, whereas I'm actually just describing how community mental health is practised in a lot of places, including some parts of the US.

I wouldn't be willing to work as a psychiatric nurse or a social worker, but clearly plenty of people are. There are all sorts of jobs I wouldn't want that other people love and vice-versa.

I would need some firm data showing plenty of people are willing to work with people who may pose a danger to them. Retail work is considered to be bottom of the barrel because you have to deal with the general public, I don’t see people lining up to spend years of their education to deal with mentally ill customers.

At least not without significant compensation, which we as a society don’t want to pay for, considering the piss poor pay for social workers and lack of mental institutions.

A large number of people have the job title "mental health nurse" or "psychiatric nurse". A majority of those people spend a majority of their time working with the most seriously ill people. For a high-income country, the US has an unusually low number of mental health nurses relative to the overall population; there are more than five times as many mental health nurses per capita in the UK, Scandinavia, New Zealand or Japan.

https://www.who.int/mental_health/evidence/nursing_atlas_200...

True, but this shouldn't be done on the streets. At some point they need to be "taken" to a safe facility.

At some point, sure. But don't dismiss the persuasive power of free food, shelter from the elements, a bed, laundry service, etc. (especially if those are being provided by the same place! ZOMG, what a concept!) to voluntarily entice most of the homeless population to a safe facility.

What happens when this entices someone who is screaming at imaginary aliens between the hours of 3 am to 5 am, uses the hallway as a toilet, and is convinced that his neighbour wants to kill him in his sleep?

Do you force-medicate them? Restrain them? Kick them out? Or just let them ruin it for everyone else? What exactly are you proposing the institution should do?

What about someone overdosing twice a week? Do you just keep sending ambulances to drive them to the ER, until they finally die, and we can feel smug and superior that, well, at least their human rights weren't infringed?

People don't need to be "taken" if they actually expect the facility to be helpful. Too often there are very legitimate reasons that people expect the opposite (e.g. having experienced psych hospitals that are basically just soul-sucking money farms optimized for "processing" patients).

Can we? The severely mentally ill, those with willful medication noncompliace and/or violent psychotic episodes, what do you propose we do with them? It's well known that many of them lack the self-awareness to even realize they are ill. Some sort of involuntary commitment is necessary.

Frankly I believe the asylum would be a better place for many of them rather than taking dumps on the streets of San Francisco. Closing them was a mistake; rather what was needed was more oversight. It would be like shuttering all nursing homes and sending the elderly back onto the streets or into their children's homes, because the cheapest ones are run like deathbed holding warehouses. In fact they've all but reappeared, we just call them prisons today, or sometimes a long-term residential psychiatric care facility.

Historically the severely mentally ill were either put to death, or placed under the custody of their immediate relatives, with the family being punished if said ill person were to cause trouble in society. This is not really an option in modern society. The severely psychotic need inpatient care, and it should be an option. Today they're getting it in jail, this is not ideal.

Bi-polar can be treated with medication and people can often lead a normal life as a result.

Yes, but in particular I'm referring to the problem of the mentally ill not taking their medication.

I’ve heard many times of bipolar people committing crime because they either decided to stop medicating (it does make you feel not good) or they lost them or something.

There is a point between individual freedom and public safety. We can’t just sigh and throw up our hands in the air.

I think schizophrenia is the much bigger problem regarding the homeless.

I agree. The majority of homeless people I encounter in NYC are mentally ill. Many are drug or alcohol dependent. It's not uncommon at all to see someone having a shouting argument with themselves. Most reek of urine. This is not how a humane society deals with this issue.

It is also not safe. Although most homeless people in the city are non-violent, it's not uncommon to read about a delusional person slashing someone across the face with a knife or pushing someone in front of a moving train.

Involuntary commitment with compassionate care, properly funded with ethically-aligned incentives, is the most humane solution. Doctors should be the ones to recommend who among the patients is ready to reintegrate into society, and those individuals should receive an apartment and a job with some kind of state or federal work program to provide a routine, though they would of course be free to seek out alternatives.

Same issue with homeless population in Portland, Oregon. It's a very divisive hot topic right now with no easy solution.

> We closed the asylums, because the long-term detention of the mentally ill is costly and inhumane. We can do better than just warehousing people in pseudo-prisons.

Apparently not, because we just kicked them out onto the streets to starve and freeze to death.

> We closed the asylums, because the long-term detention of the mentally ill is costly and inhumane. We can do better than just warehousing people in pseudo-prisons.

How?

This is a serious question.

Right now, we are housing them in open-air prisons - the various homeless ghettos in Vancouver, San Francisco, Seattle, etc.

What exactly do you propose we do for someone who is unable to, due to mental illness:

1. Maintain their living space, or themselves in a remotely neighborly manner. (All the problems the librarian faces? Imagine living in a shelter/state housing, next door to that.)

2. Take their medicine.

3. (Bonus). Do anything, or consent to do anything about their substance abuse problem.

These are not traits that most homeless people have. Most homeless people can be immediately helped by housing first, etc, etc. But these are traits that some homeless people have. And since you're hand-wringing about institutionalization, I would like to hear what you propose, as an alternative for them.

>I would like to hear what you propose, as an alternative for them.

https://en.wikipedia.org/wiki/Assertive_community_treatment

So, "Medical professionals should spend more time helping their patients."

That's great. I fully endorse that. That's an improvement over them spending less time helping their patients.

How does this help someone who refuses to be treated? What do you do until they are willing to be treated? Keep them on the streets?

If someone is a danger to themselves or others you can detain them and force them to take medication against their will.

If they're not a danger to themselves or others you can't do either of this because they're both significant interferences with human rights. But it's important to recogise that forced hospitalisation doesn't always work, and that keeping someone banged up in hospital for two years is an expensive injustice.

So you provide assertive outreach - teams that maintain contact with people who deny their illness, and who aim to work with the patient until they're ready to engage with services.

https://www.theguardian.com/healthcare-network/views-from-th...

> If someone is a danger to themselves or others you can detain them and force them to take medication against their will.

It's possible to be someone who is not a danger to yourself, or others, and also be someone who is impossible to live next to. See: The 'harmless' guy who is screaming at invisible aliens at 3 am in the morning.

Do you let that guy into the shelter? Or do you let him carry that behavior out on the street?

What about the guy who is ODing over and over again? Can he be institutionalized? Or is he not being a danger to himself? When someone downs a bottle of sleeping pills once a week, we consider them suicidal, and we can mandate treatment - but shooting up heroin until you're passed out, barely breathing under an overpass isn't considered self-harm?

>So, "Medical professionals should spend more time helping their patients."

Assertive community treatment is about much more than conventional healthcare interventions. When delivered properly, it's an integrative and interdisciplinary approach that includes psychiatrists and psychiatric nurses, social workers, occupational therapists and peer mentors. People with severe mental illness need medical care, but they also need good housing, support in maintaining that housing, meaningful daily activity and a network of social support. Most of that support can be provided by non-medical practitioners.

If someone is offered housing and doesn't want it, they are under no obligation to take it; they have the right to make choices about their own life, even if those choices don't seem rational. A lot of people genuinely do feel safer on the streets, which is in part a sad indictment of the standard of housing on offer to the very poorest.

If someone doesn't want to work with a mental health practitioner, send a social worker. If they won't talk to a social worker, send a peer mentor. If they don't want to work with anyone, train the local police in mental health crisis management so that they can provide positive interactions.

As is so often said in addiction treatment, you can't make someone want to get better. The idea that locking people up against their will consistently facilitates effective treatment is wishful thinking at best. Some people just need time, some need the right circumstances, some need a long and patient process of rapport-building.

Some people are just very difficult to treat, but that doesn't mean we should either abandon them to fate or lock them up indefinitely to keep them out of sight and out of mind. There are a whole spectrum of useful, evidence-based interventions, many of which don't particularly resemble what we might think of as psychiatric care. With a bit of imagination and sufficient funding, we can deliver good outcomes for people who seem to have intractable problems.

Is there a state or country that you think is doing an excellent job of taking care of their mentally ill citizens?

There's no one system I'd point to as being ideal, but there are plenty of excellent examples of best practice.

The UK does many things badly wrong, but one crucially important programme is Early Intervention in Psychosis. EIP works with young people experiencing a first episode of psychotic symptoms, with the goal of preventing that episode from developing into an enduring psychotic illness. A majority of patients should be treated within two weeks of being referred. A care co-ordinator provides a single point of contact for the service user, guiding them to access clinical, behavioural and psychosocial treatment. The service provides integrated care for comorbid physical conditions and support for social issues such as social isolation, unemployment and homelessness. The available evidence suggests a 90% reduction in premature death and cost savings of £15 for every £1 spent.

https://www.england.nhs.uk/mentalhealth/wp-content/uploads/s...

>We can do better than just warehousing people in pseudo-prisons.

Interestingly, some years ago I watched a documentary (Frontline, most likely) on mentally ill people in jails/prisons. If true, it was eye opening, and changed my perception on a lot of things. They followed some of the patients around, including when they were released. The general takeaways were:

1. The mental asylums that were shut down were truly horrible places.

2. Currently the only reliable place these people get medical help for their mental issues is in prisons. And it's a much better experience than those asylums.

3. For a number of prisoners/former prisoners, life in prison was better than life outside and homeless - not because of shelter/food, but because they got treatment. Regression rates are high once they are released.

4. Providing voluntary mental health help on the outside will help some, but not many. It's just one of the problems with a number of mental illnesses that if you regress a little, you likely are not going to voluntarily seek help. The key is not to regress. When you have no family support and no help in job, housing, etc, the likelihood of regression is much higher.

But you're ignoring a simple reality: people go to libraries because there is no other place to go.

Why as a society have we decided that libraries are where hurting people are to be herded? That librarians are their outlet to be heard?

We need more and richer commons, and particularly places that encourage healthy people to stay healthy and sick people to get well.

When did you decide that libraries are waystations for the wounded, as a member of society? I'm curious, because this underlies your notion.

Personally, I see it in practical terms. Regarding the policy of using a library as a resource center, giving people access to computers and training materials is a pretty darn good idea for folks who want to enrich their careers or other domains of life.

The comment you are replying to answers your question.

Q. Why as a society have we decided that libraries are where hurting people are to be herded?

A. "...we find the idea of involuntarily committing psychiatric patients to be unpalatable these days..."

That's sort of right. It's not that we find it morally unacceptable to involuntarily commit people.

It's that we don't want to pay for it. We shut down all the state mental hospitals. Which moved that population to jails, prisons, and the streets.

Taxpayers may have thought that mental asylums were expensive, but jails are very expensive. It's a lot cheaper to keep a schizophrenic in a state hospital. So I'm not sure that the decision to empty the state hospitals was driven by taxpayer stinginess.

The whole thing is complicated. Drug companies in the 60s and 70s advertised their antipsychotics very hard. They persuaded the public that drugs could cure mental illness. That was a big force behind the emptying of the hospitals.

Lots of short-sighted thinking.

The 1965 Medicaid law changes excluded any reimbursement to psychiatric hospitals with more than 16 beds.

That killed the state run hospitals. Running a 16 bed or less facility in a profitable way with Medicare reimbursement isn't possible. The money moved to other social programs.

Deinstitutionalization was not driven by taxpayers. Taxpayers have been fighting a losing war against growing social spending since 1913, and particularly since 1965. It was sociologists and other social commentators who considered it a form of oppression that drove the movement.

The answer is that advocates “care” for these populations enough to ruin a public space that they don’t use in their leafy suburbs. (The suburban towns don’t put up with homeless and crazy people... they get picked up for their safety and shipped off to the city.) The rights of the crazy guy taking a dump in the middle of a library are more important than the people looking to read or learn or to have a place to be.

But that “care” for these people doesn’t extend to actually providing meaningful ways to improve their lot.

>Why as a society have we decided that libraries are where hurting people are to be herded?

We didn't. We instead decided that we have no right to interfere with decisions made by adults who cannot make decisions on their own.

>We need more and richer commons, and particularly places that encourage healthy people to stay healthy and sick people to get well.

Like what? What is an example of 'commons' where drug addicts or sufferers from schizophrenia can decide to go 'to get well'.

A Librarian's Guide to Homelessness

https://www.youtube.com/watch?v=FYiEEhhrFh4

Not just for librarians.

A good mix of empathy and realism, it helped me understand the social issues much better.

While obviously some are mentally unstable, and that's what drives them to the streets, what's being ignored in this conversation is that being on the streets drives many to mental instability.

Being homeless makes it difficult to find safely and sleep. Even a few days of that condition is extremely mentally taxing. Months or years? It's no surprise that so many of the homeless we see have mental issues. No surprise at all.

Lots of people who are homeless aren't living it rough on the streets, they're couch surfing or sleeping in their car. It's generally the people with some sort of mental illness who end up in the streets, because they are too unstable to be tolerated anywhere else.

I don't think there's any evidence to show that being homeless causes schizophrenia or other forms of psychosis. Depression and bitterness, sure, but likely not psychosis.

The first thing I found when looking was references to this study:

https://www.heraldsun.com.au/news/breaking-news/loose-link-f...

> Their results, released this week, reveal just over 30 per cent had a mental disorder.

> "The figure was much lower than the community perception and what other researchers had put out there," Dr Johnson told AAP.

> About 15 per cent had a mental illness before becoming homeless, while slightly more, 16 per cent, developed a disorder while on the street.

Sure, one study in one city, but assuming it's roughly correct, roughly half (if not more) of the homeless with mental illnesses developed them after living on the street.

So in addition to simply helping people not, you know, be homeless anymore, it would very likely reduce the amount of mental illnesses suffered by those who are and have been homeless.

Again, I think this author is equivocating on the word homeless. Most homeless are not the people yelling incoherent obscenities on the sidewalk.

Additionally, with something like schizophrenia, a person can have the disease and under medical care be able to function at a high level. If, for some reason, they fall out of medical care and stop taking their medication, their symptoms can rapidly spiral out of control and lead to the sort of paranoid, potentially violent, homeless person described in the librarian article. This doesn't mean their mental illness was caused by homelessness, it just means homelessness enabled it to fully manifest itself.

The study said

> About 15 per cent had a mental illness before becoming homeless, while slightly more, 16 per cent, developed a disorder while on the street.

If they were suffering from schizophrenia but it was controlled with treatment they would fall into the category of "had a mental illness before becoming homeless", not "developed a disorder while on the street".

I'd have to politely disagree. Formerly being one of these "hopeless cases", and now being a productive, healthy member of society, I feel like I have some insight into the matter.

Treatment, support and stability help immensely. We do none of that for the must vulnerable members of society. People don't end up like that overnight usually, it takes their mental health being neglected a long time. Often times the trauma starts in childhood. Can you blame them for that?

A real issue is ignorance and the resulting lack of compassion. Everyone is insecure about something, but some people make themselves feel better by judging others. The fact of the matter is we are all a few bad strokes of luck away from squabbling in the gutter. Some egos are too fragile to admit that.

Some unfortunate people may be unable to live in society, but they are in the minority and you don't know if they will respond to treatment until you try.

I am astonished that you put drug dependence in the same category as just plain violent. Mental health issues aren't a moral failing, and treating them as such further ostracizes already marginalized people.

Antisocial behavior arises when people feel rejected by society. Instead of blaming individuals from your position of privilege, perhaps you should consider the society and systems that created them.

I hope you never find out just how thin the line is.

> The kind of people who are giving the author PTSD aren't going to be helped by free housing, free money, or free anything other than free medical care, and in the extreme cases, institutionalization.

That isn't really true. Even among those with mental illness, we can divide those into two groups, those whose illness isn't treatable using current methods and those who are.

For the first case, "free healthcare" doesn't work, because they're incurable. The only real option for a violent person with an incurable mental illness is prison or something so similar to prison as makes no difference in practice.

For the second case, free money does work, because when the problem is access to healthcare, money can be used to buy healthcare. (And when the problem is something else, money can be used to buy something else.) Particularly when you combine this with some kind of system for a homeless person to be evaluated by a doctor when referred by someone like this librarian. Because once they go to the doctor and get what they need in terms of medication, once they're on the medication they would have the wherewithal to use the money to continue taking the medication (and then ideally get into a state where they no longer have to live on the street).

For the first case, free healthcare does work because they get institutionalised even if they don't have money. If you have a decent system, those places are a million times better than prisons.

We had state institutions at one point. They were basically prisons.

Moreover, any kind of forced institutionalization is always "free" -- it's not as if you can get out of it for lack of money.

Other countries, those with a somewhat decent social safety net, do not have such a big problem with homelessness. Particularly not with homeless people making public libraries unusable for the general public.

Is that really so? Homelessness rates in the US are below those in Sweden, Germany, France, Great Britain and Australia:

https://en.wikipedia.org/wiki/List_of_countries_by_homeless_...

This is 100% true, but I wonder if the right level of abstraction for the 3rd largest country by population and 4th largest by area.

The USA undeniably has a low macro rates of homelessness overall, but I wonder if it has high micro levels of homelessness, e.g. Sydney seems to have lower rates of homelessness than San Francisco or Seattle, even though Australia has a higher homelessness rate than the USA overall. I wonder as I can't find any data that uses the same measurements across cities and countries and is easy to compare.

On numbers, Seattle has 12,000 homeless according to wikipedia, and I can't find similar numbers for Sydney. Given Sydney is about 15% larger than greater Seattle, it would need to be closer to 14,000 to be the same. I doubt Sydney has that many Homeless, but with no data I guess it may.

I could be completely off base here, but I do think the USA has some really concentrated pockets of homelessness, and that skews people's views, in both directions, based on personal experience.

The question is, does homelessness become more of a problem if it is "more concentrated"? I would argue that for the homeless individual, it actually doesn't. It's in fact probably better to be homeless in a place that is already accustomed to homeless people.

Of course for the perception of a non-homeless person, the problem will appear more drastic with a higher concentration.

That list is a great example on how you have to treat wikipedia with a healthy dose of scepticism. It's original research of the worst case: A list of figures from different decades(!), extracted from random news sites, without any trace of even trying to explain that there is no globally accepted definition of homelessness and that those numbers likely measure very different phenomena.

Furthermore, most of these figures includes people that are insufficiently housed like on a friends couch, in a windowless room, in temporary shelters and such, and do not tell you much about the population of people "on the streets".

Fair enough, but you literally gave zero evidence for your claim that "Other countries, those with a somewhat decent social safety net, do not have such a big problem with homelessness".

You should at least consider the possibility that what you said isn't really true and just fits your preconceived notion of a heartless US society versus a supposedly more social environment in Europe.

Heartlessness isn’t a factor here. At least individually I’d say that people over here are way more indifferent towards the homeless. There is very little enthusiasm in terms of volunteering and such.

Where is over here?

The US leads the world in volunteering. https://www.oecd.org/els/family/CO4.1-Participation-voluntar...

You can also look at BLS info: https://www.bls.gov/news.release/pdf/volun.pdf

Most cities have programs with volunteering with the homeless, just visit a nearby church and ask. Clothes, food and resumes are pretty popular things to help with.

Thats my point. There is an abundance of compassion, but a dearth of effective social security. The welfare states or Europe are a form of institutionalized compassion, but they are eroding fast.

It appears to be compatible with numbers from the OECD.

http://www.oecd.org/els/family/HC3-1-Homeless-population.pdf

If you look closely, you’ll find that this data has exactly the same problems. Japan has 0.0% homelessness, because they are only counting people sleeping on the street. The millions of people living in trailer parks would likely be counted as homeless in a lot of the countries on that list. Some of these figures are official, some come from advocacy groups. It is not possible to use this data for international comparisons.

You seem to have shifted the burden of proof to others to disprove your unsubstantiated claim, and then criticized the quality of the evidence offered.

Please raise the level of discourse here by offering new information to support your claim.

>and in the extreme cases, institutionalization.

Worse than that, the family and loved ones of the homeless individual have almost no rights to institutionalize them to get them the care they need. It is unbelievable that we're OK with it.

I've had this conversation with people in other countries when they ask why there are so many homeless in America. I ask them what their country does with mentally unstable homeless? They're response is they are not allowed to live on the street and they are "picked up".

We can decide to let people have complete autonomy or they can be "picked up".

Picked up means that they are taken freely to an hospital, they give them a bed, food, they check their conditions and can sleep there a night or two. At least in Italy, where my parents worked in hospitals and took care of many homeless or just troubled people.

It's not like the Nazis taking prisoners to the camps...

Mhh, in my country they're only picked up when its too cold to stay outside. Other than that we have many shelters where people can stay overnight for a euro or so.

As there are in LA and NYC. Many people don't want to go for whatever reason so they stay on the street.

A lot of these people, I would wager the majority , had bad childhoods. Resulting from vicious cycles caused (in part) by poverty. I would also wager in a fairer parallel universe where this wasn't the case, a good number of these people wouldn't have grown up to be as mentally ill as they are.

Schizophrenia -- responsible for much of the extreme behavior that librarians see -- is an organic disease that affects both the rich and poor at equal rates. It has nothing to do with how you were raised.

It's true that wealthy families can afford much better care for their schizophrenic family members, but poverty certainly does not cause schizophrenia.

Otherwise, I strongly agree with you that generational poverty is a critical societal problem to be solved.

>Schizophrenia -- responsible for much of the extreme behavior that librarians see -- is an organic disease that affects both the rich and poor at equal rates.

A laundry-list of adverse life experiences associated with poverty are known to increase the risk of schizophrenia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181718/

correlation or causation?

Of course that study can’t prove causation (not going to do a randomized trial on risk factors that cause schizophrenia), but they only looked at risk factors prior to onset, so that should be a good proxy.

That's mostly a laundry list of hypotheticals, aside from the seasonal study which had some statistically significant data indicating correlation. All the childhood environmental factors that might have some small relation to poverty were described in that section as "proposed" or "discussed".

It's entirely possible that some environmental factor associated with poverty might exacerbate the genetic factors responsible for the disease, but all things considered, schizophrenia is known to be a disease that affects rich and poor alike, across the globe, across cultures.

I suspect free housing and other social safety nets would prevent people from deteriorating to this state, or at least mitigate the effects.

I imagine other developed countries don't have this problem to this extent. What do Denmark or Japan do that we can learn from?

The US does pretty well in terms of homelessness rates (see link above—half the rate of Sweden). Japan’s is a lot lower, but Japan relies primarily on private charity to deal with homelessness. (Mental health issues are much more stigmatized than they are in the US. It’s relatively recently that Japan even started seriously studying the problems of homelessness at the government level.)

The US apparently has a much higher rate of unsheltered homeless people though. This is a quora answer, but there are sources at the bottom: https://www.quora.com/Is-homelessness-as-bad-in-Scandinavia-...

The problem is that you don't offer any solution. Sure, some homeless people, schizophrenics, and sociopaths are unpleasant to deal with and will find themselves unwanted wherever they go, both due to their own actions and due to prejudices and fear.

They go to libraries, house entrances, metro stations, and so on because they have no other places to go. Putting them out of your sight will not make the problem go away.

The solutions are obvious and not mysterious at all. What do most of them need? Good social programs, free health care, job programs that work and are not just designed to "improve" statistics, personal mentoring, places to go where their few belongings are safe and they are not surrounded by criminals and troublemakers all the time, proper psychiatric care, drug help centres with medical professionals who are not allowed to cooperate with the police except in case of capital crimes, and so on and so on. What do they not need? Well, there are always hard cases and dangerous criminals can be mentally ill like anybody else, but generally speaking, as a rule of thumb, the last place you'd want to put them are US prisons, because the people who leave them are more likely to be mentally ill than the people who enter them.

The quality of a society can be measured directly by how they deal with their outcasts and troublemakers.

> The solutions are obvious and not mysterious at all. Good social programs, free health care, job programs that work and are not just designed to "improve" statistics, personal mentoring, places to go where their few belongings are safe and they are not surrounded by criminals and troublemakers all the time, proper psychiatric care, drug help centres with medical professionals...

All these things exist in many developed countries, but they don't solve the problem either. Schizophrenic people in particular are unlikely to actually accept help. They're incapable of appropriately judging the reality around them. They can't tell if somebody is genuinely trying to help or if they're "out to get them".

So you would have to force them into psychiatric care, but that's often not legally possible, and for good historic reasons.

>and for good historic reasons.

Is it? I'm not convinced that we haven't over-inflated the harm of psychiatric institutions from 50s and 60s and 70s. I wonder if the spate of horror movies set in mental institutions are partly to blame in addition to over-focus on practices that have long been banned.

> All these things exist in many developed countries, but they don't solve the problem either.

You're just claiming this without providing any evidence and I believe this to be false (in tendency), unless by "solving the problem" you mean "perfectly solving all problem in each and every case". In general, adequate medical treatment and improved living conditions will improve the situation. With proper medication and treatment people can live with schizophrenia.

As for putting people who pose no threat to the public or to themselves into closed institutions against their will, this is obviously immoral and not even worth discussing. At the meantime, every country I know of already as laws for mandatory closed therapy of people who actually pose threats. That includes the US.

Overall, it's not clear to me what you were trying to say. Given that the obviously immoral solution is out of question, that there always remain some problem with the outliers for which the help doesn't work? Of course, these will always exist, just like there always will be criminals. But that's a truism.

> With proper medication and treatment people can live with schizophrenia.

Am I supposed to just repeat myself? Schizophrenics refuse treatment a lot of the time. They can't tell you want to help them when they have paranoid delusions. Then what do you do? Unless they're provably a threat, you have to let them go their way, unmedicated.

> Overall, it's not clear to me what you were trying to say. Given that the obviously immoral solution is out of question, that there always remain some problem with the outliers for which the help doesn't work?

Your "obvious solutions" are not solutions. You make it sound like a solvable problem. It's not. It's really a tradeoff between public safety and personal freedoms.

Mental illness is not an "outlier". About 30% of the homeless suffer from severe mental illness:

https://web.archive.org/web/20121231000856/http://www.calpsy...

30% is fairly low, and your suggestion that schizophrenics refuse treatment a lot is pointless. Some of them refuse it, other do not refuse it, and you help those who do not refuse it.

The situation of homeless is not as bad in countries with better systems as it is in the US, precisely because, as a tendency, their situation can be improved and less is done in the US than in other countries. The effectiveness of social welfare programs, health care, and so on, is a purely empirical question that can be measured effectively. Contrary to popular belief, these are not questions of political opinion. (What is a matter of political opinion, of course, is how much you want to spent and who is going to pay for it.)

You could e.g. start by helping the 70% of those homeless who, according to your own statistics, do not suffer from severe mental illness. That's already the vast majority.

As for the remaining 30%, the suggestion you're trying to make, that they are all hopeless cases, is outright bizarre. We know that schizophrenia can be treated with medicaments and that not all of the people diagnosed with schizophrenia refuse treatment. You could start by treating those who want to be treated, for example.

Finally, you still haven't bother to tell anyone what to do about the 30% you incorrectly portray as being untreatable, because they allegedly refuse treatment.

If your suggestion is to put them into mental institutions against their will, even when they pose no threat to the public or themselves, then my reply is that you need to check your moral compass. This is prohibited by law and by very basic moral considerations. If you have another suggestion, rather than stating the obvious truism that not every schizophrenic can fully adapt to society or be treated effectively, then I'm all ears, and so are myriads of medical professionals and street workers.

Right now, to me you merely come across as someone who doesn't really have anything to say about the topic. As I've said, it works better in many other countries, so your idea of not helping at all does not really seem to be very convincing to me.

> 30% is fairly low, and your suggestion that schizophrenics refuse treatment a lot is pointless. Some of them refuse it, other do not refuse it, and you help those who do not refuse it.

Those who don't refuse treatment tend to not be homeless. Maybe you should have a conversation with a social worker or a medical professional about homelessness if you still believe homelessness has an "obvious solution".

> You could e.g. start by helping the 70% of those homeless who, according to your own statistics, do not suffer from severe mental illness. That's already the vast majority.

Yes, we can have another conversation about how helping drug addicts is really difficult. We can talk about how hard alcoholics can't hold jobs or maintain a household. We can talk about all kinds of issues that are not solved by simple having more social programs than we already have.

> Right now, to me you merely come across as someone who doesn't really have anything to say about the topic.

You come across to me as someone who doesn't really have a good understanding of the actual problem. All you have to say is "the solution is obvious, more welfare programs! Throw money at the problem, it'll disappear!". It's just not true. No country in the world has "solved" homelessness while maintaining the level of personal freedom that you yourself seem to be vigilant of.

My point is not that we should institutionalize all these people, or that there shouldn't be more programs available. In fact I would argue that drugs in particular need to liberalized to keep addicts in the programs.

> Those who don't refuse treatment tend to not be homeless.

You just literally said that 30% of the homeless are severely mentally ill. That means that 70% of the homeless are not severely mentally ill.

And you have not proposed any solution or way to tackle the problem at all. Not a single suggestion.

> You just literally said that 30% of the homeless are severely mentally ill. That means that 70% of the homeless are not severely mentally ill.

In context of the reply, the sentence is: Those schizophrenics (not "those homeless") who do not refuse treatment tend to not be homeless.

> And you have not proposed any solution or way to tackle the problem at all. Not a single suggestion.

I don't have a solution and neither does the parent. Why should I make poorly informed suggestions on what should be done? To appear virtuous? Well here you go:

Every homeless person should get a Macbook and free Javascript courses so they can get a job in San Francisco!

Is that what you expect out of people?

The parent has suggested a number of solutions, and you have not presented a convincing argument why any of those solutions would not help. You started by insinuating that most homeless are incurably schizophrenic. Then you looked it up on the Internet and found out some (fishy) statistics that stated that only 20% - 40% of all homeless are seriously mentally ill, so you backtracked and replaced your original suggestion with the statistically incorrect claim that 30% of all homeless all incurably schizophrenic and refuse treatment without presenting any evidence for that claim either. (Hint: This doesn't follow from the revised statement you gave in your last reply, for which you have also presented no evidence btw.) And when pressed about what it is you want to say, your overall point was that nothing can be done to help those schizophrenics among the homeless who refuse help. But the other poster already conceded that there is always a certain percentage who cannot be helped, so the two of you don't even disagree.

The only point that you backed up with some citation was the claim that only 20% to 40% of all homeless are seriously mentally ill, which seems to support the idea that it may be possible to start helping the majority 60% - 80% of homeless who are not seriously mentally ill. And, to make this clear, the vague suggestion that most or many homeless people who suffer from schizophrenia often refuse help wasn't really informative or helpful. Not without actual numbers and actual evaluation of help programs.

Your repeated suggestion that there is no solution and nothing can be done has certainly not convinced me.

> The parent has suggested a number of solutions, and you have not presented a convincing argument why any of those solutions would not help.

There's a difference between "a solution" and "mitigation". All those programs that the parent mentioned do exist in so-called "welfare states" like Sweden, France or Germany. Yet, these countries have higher homelessness rates than the US.

> You started by insinuating that most homeless are incurably schizophrenic.

I actually didn't. I said that schizophrenics in particular are likely to refuse help. I didn't say all schizophrenics refuse help or that all homeless are schizophrenic.

If you can't solve the problem of getting those schizophrenics off the streets (without force), you can't have a solution to homelessness, period.

> Your repeated suggestion that there is no solution and nothing can be done has certainly not convinced me.

I didn't say nothing can be done. I particularly don't care about "convincing" some guy on HN with poor reading comprehension. Have you done anything besides complaining about my posts? Go educate yourself on the topic if you want to "prove me wrong" or something.

> I didn't say nothing can be done. I particularly don't care about "convincing" some guy on HN with poor reading comprehension.

You're the last person on HN who should tell other people about reading comprehension, at least judging from this thread.

> > You started by insinuating that most homeless are incurably schizophrenic.

> I didn't say all schizophrenics refuse help or that all homeless are schizophrenic.

That's a typical example of your reading comprehension, which is based on constantly shifting the goalpost in order to "save face." And that is the reason why you're so unconvincing. You did start by insinuating that most homeless are schizophrenic and that most schizophrenic refuse to get help. Both statements turned out to be plain false according to your own Internet research - which you obviously conducted because you're not very familiar with the topic, otherwise you would have mentioned your single data point, namely the paper you linked to, right from the start. You dynamically adapted your claims instead of doing the mature thing of simply admitting that you were wrong and less homeless people than you thought were mentally ill.

> There's a difference between "a solution" and "mitigation".

This kind of hairsplitting is an immature reaction when someone points out inconsistencies in a post.

The fact is that in the end you said almost nothing, but you managed to achieve that goal with erroneous reporting of statistics, peppered with several false dichotomies and a lot of insinuation. So some percentage of the (i) 20%-40% of homeless that are seriously mentally ill might (ii) be schizophrenic, and of those (iii) some other percentage might refuse treatment, and for (iv) those there may be no solution. Nobody has ever denied that in this thread, and what is even more stunning about this conversation is that you have provided 0 evidence for claims (ii)-(iv). Zero. No data, no statistics, not even an argument that would withold basic scrutiny. That's not a good track record, especially not for HN.

Now you're again shifting goalposts and there is a new insinuation, of course. Now suddenly you're coming up with general homelessness rates. I suppose the insinuation this time is that mitigation strategies of welfare states like Sweden, France, and Germany don't help against homelessness - which is, of course, another obvious nonsense that could not possibly be backed up by looking at homelessness rates alone. Again, you're using the wrong data to insinuate something while keeping the actual position as vague as possible. You could just as well have mentioned North Korea and Jordan as positive examples with alleged 0% homelessness. Or that Mexico has a much lower homelessness rate than the US. Or that a welfare state like Portugal has a much lower homelessness rate than the US, too. And so forth. Fact is, of course, that homelessness rates cannot be compared in this way and that public policies need to be evaluated much more carefully by looking at their concrete effects.

> Go educate yourself on the topic if you want to "prove me wrong" or something.

That's called "projection" in psychology.

> And that is the reason why you're so unconvincing. You did start by insinuating that most homeless are schizophrenic and that most schizophrenic refuse to get help.

I made a plain statement. I don't have the need for "insinuations". If I had wanted to say anything about "most homeless", I would've used the word "most", as I have in all other instances where I used the word "most".

By using the word "insinuate" you are yourself weaseling out of having misread what I said. You can't just say I said something that I didn't say. So I must've "insinuated" it and you get to decide what I insinuated, not me. That's just really poor debating tactics.

> Both statements turned out to be plain false...

I never made such statements. Goalpost moved.

> ... which you obviously conducted because you're not very familiar with the topic, otherwise you would have mentioned your single data point, namely the paper you linked to, right from the start.

You are correct in guessing that I looked the number up after writing the comment.

> You dynamically adapted your claims instead of doing the mature thing of simply admitting that you were wrong and less homeless people than you thought were mentally ill.

You're basically engaging in mind reading now. My claims didn't need adaption because I never said anything premised on the proportion of schizophrenics among the homeless. Whether 30% is "more or less" than what "I thought" is irrelevant. I didn't have a number in mind at all.

> This kind of hairsplitting is an immature reaction when someone points out inconsistencies in a post.

Another poor debating tactic - accusing the other side of "arguing semantics".

> ...several false dichotomies...

Really? Cite two.

> That's not a good track record, especially not for HN.

Dude, you're not exactly helping out with these kinds of posts...

> About 30% of the homeless suffer from severe mental illness

80.2 million Americans (25% of the 325 million total population) suffer from mental illness so severe they take drugs to treat their condition:

https://www.cchrint.org/psychiatric-drugs/people-taking-psyc...

This does not include the number of people who suffer from mental illness that does not require drugs for treatment or those who would benefit from drugs but who do not wish to or can not afford to take them, or who are undiagnosed. So the actual number with severe mental illness is much higher than 25% of the population.

Above, DanHulton tracked down a study that also found that 30% of homeless suffer from mental illness:

https://news.ycombinator.com/item?id=19707763

https://www.heraldsun.com.au/news/breaking-news/loose-link-f...

> Their results, released this week, reveal just over 30 per cent had a mental disorder.

> "The figure was much lower than the community perception and what other researchers had put out there," Dr Johnson told AAP.

> About 15 per cent had a mental illness before becoming homeless, while slightly more, 16 per cent, developed a disorder while on the street.

Since only 15 percent were ill before becoming homeless, this means that homeless people are much less mentally ill than the general public.

It is a disproven myth that homeless people are more likely to be mentally ill than the general public. It is also a dangerous myth since belief in this myth drives nearly all discussion and proposed solutions (such as institutionalization, imprisonment and forced drugging) to address the problems of widespread poverty, lack of universal basic medical care, lack of affordable decent shelter, etc, in the US and in several other industrialized modern countries.

> 80.2 million Americans (25% of the 325 million total population) suffer from mental illness so severe they take drugs to treat their condition

That's not the same as having "severe mental illness". Doctors in the US hand out psychomeds like candy to anyone who has a mild depression. That's how you get to 25%.

> It is a disproven myth that homeless people are more likely to be mentally ill than the general public.

It isn't. You just took some numbers from one bucket, put them next to numbers from another bucket and then concluded that for some unexplained reason, it's actually the people who become homeless that have on average better mental health than the general population. Non-Sequitur.

Mind you, I never said that the majority of homeless people are mentally ill, but there's a set of hard cases that you will literally not be able to help with any program that is meant to get them off the streets.

>As for putting people who pose no threat to the public or to themselves into closed institutions against their will, this is obviously immoral and not even worth discussing.

Why is it obviously immoral? Is it moral to allow people who cannot make decisions for themselves to live in squalor and filth?

Looking at it another way, municipal governments set living standards for housing, with requirements around sanitation, access to clean running water, heating, etc. ... unless you're a drug addict or a sufferer of mental illness, in which case go right ahead and live in a tent city surrounded by filth and vulnerable to the elements, disease and crime?? That's your moral option? Ask politely the individual if they would not like to live in squalor and if they say 'no', leave them be?

> Why is it obviously immoral?

Why is it immoral to lock away people against their will, people who have not committed a crime? Because freedom is a basic human right.

The moral option is good street work, effective welfare programs and to give people housings rather than let them live in tent cities in filth and disease, something against which to which other poster has vigorously objected without providing any argument for his position other than falsely claiming that these people are all incurable schizophrenics.

What's wrong with people in the US that this even has to be discussed?

>Why is it immoral to lock away people against their will, people who have not committed a crime?

That's unfair. It isn't right to talk about doing things against the will of an individual who isn't a free actor due to their condition. This is very well established notion legally, culturally and morally. For example, if a schizophrenic person commits murder, their condition is a mitigating factor in their sentencing and will prevent them from simply being locked up with the general population.

Similarly, you're already treating them as individuals incapable living up to the responsibilities of living in society. All municipalities have zoning laws to control where citizens can live and laws against squatting in tent-cities or on a sidewalk and living in squalor and filth, without proper sanitation, and protection from elements - yet somehow you still argue that those laws should not apply those individuals. So you're trying to have your cake and eat it to. On one hand, you're saying forced institutionalization where care could be provided, is wrong because those individuals CHOOSE not to be institutionalized, and on the other hand, you're arguing they shouldn't be held to the same responsibilities as other citizens because they can't help their situation.

This position is arbitrary and incoherent.

Finally. I disagree with your contention that institutionalizing people for the purpose of providing care (not locking them up - as you called it) who aren't capable of making their own decisions is immoral - and you haven't attempted to show why it is, you just assert it as a fact - which it isn't.

>What's wrong with people in the US that this even has to be discussed

I'm not American.

> I disagree with your contention that institutionalizing people for the purpose of providing care (not locking them up)

Speaking about England: most of the people I talk to who've been detained under section of the mental health act (involuntarily committed to hospital) talk about it as being locked up, even if they're on an unlocked ward.

There are strict legal protections in place to prevent abuse of powers, although these aren't always being followed.

There has recently been a review of the English law to see if too many people are being detained.

You should view this as more severe than a prison sentence, because that mindset allows you to put in place the protections of freedoms needed to guard against abuse.

Your arguments are based on various false dichotomies and false analogies.

I have given a reason why incarcerating adults who have not committed a crime against their will is obviously immoral, namely because freedom is one of the most fundamental human rights. Of course, there can be reasons that might outweigh this right, for example when someone has committed a serious crime and there was a fair trial. Another reason would be the medical assessment that the person would likely severely harm himself or others. For the latter, the hurdles are extremely high. You can ask your lawmakers why they think they should be high. They will probably tell you that's because freedom is one of the most fundamental human rights.

"Caring" for someone is traditionally not considered a sufficient reason. And that includes parents, who are definitely not allowed to lock away their children indefinitely (as a reply to the other poster, who seems to be even more confused than you).

> you're arguing they shouldn't be held to the same responsibilities as other citizens because they can't help their situation.

I have never argued for such an absurd claim at all, in any form whatsoever.

>I have given a reason why incarcerating adults...

You haven't actually answered the one objection I have, namely, why do you think it moral to let distressed individuals who cannot make decisions for themselves live in filth and squalor. Apparently, this is a human right - which is insane.

But let's leave it at that. I'll simply state that I disagree with your position. Moreso than that, I find that position highly immoral.

>I have never argued for such an absurd claim at all, in any form whatsoever.

I didn't say you argued it, I asked what your position is on that. It is actually illegal to pitch a tent on a sidewalk and live there. It is illegal to setup a 'tent city' for purpose of long-term habitation. There are plethora of laws preventing that kind of behaviour. And I get it, you don't admit to the moral imperative of institutionalizing those individuals to provide care, but then are you OK with enforcing laws on the books against those individuals - because that isn't done either if you go to cities like San Fran and LA and enforcing those laws would lead to heavy fines or incarceration, if you treat those individuals as rational actors expected to live up to the responsibilities of living in a society.

Plenty of individuals who can make decisions for themselves live in filth and squalor, too. As long as they don't cause serious harm or violate other basic moral standards like the freedom of others, right to property, etc., people's life choices are not and should not be controlled by the state.

> Apparently, this is a human right - which is insane.

It is one of the most fundamental human rights and not insane at all. Some scholars would even argue that autonomy is a defining characteristics of being a moral agent.

Every human has a right to make mistakes, too.

Generally, freedom can only be restricted when serious harm would be caused otherwise. There used to be a consensus about this in every capitalist democratic society, and I still think there is one. That's why your reply is kind of surprising to me.

> are you OK with enforcing laws on the books against those individuals

The laws are the same for everyone, whether they are homeless or not does not play any role. otherwise the law is unconstitutional. At least that's how it works where I live.

To answer your question: Of course, I'm not fine with any kind of laws that would be specifically bad for homeless. Imposing fines on people who cannot pay them is pointless and there is something wrong with a law that does it. Replacing fines by incarceration when a person could not possibly pay the fine is equally stupid, and btw in many countries this is not how it's done. Where I live you can declare personal bankrupcy in a similar way as companies can do it. You will still have to pay off your debts once you have a job, though.

If your laws would put homeless in more misery than putting them into mental institutions against their will, then there is something wrong with those laws. Besides, people don't set up tent cities because they prefer to live in tents. This is simply false and where I live such tent cities don't exist. Ghettos and tent cities hint at deeper problems in your country, problems that will likely not be solvable by reforming laws alone.

I hope for the sake of the homeless, people like you are not involved in defining any future policy.

On the other hand, you can take solace in the fact that your perspective is the one that governs homeless policy today ... and you can see the end result.

Well, one thing is sure, that you should never be put in charge of designing future policies for how to deal with homeless people, given the atrocities you're suggesting.

How about keeping 4-15 year olds locked away against their will, when they'd much rather run out into the street than be in the kindergarten or school? Or e.g. dragging them away from the candy aisle by force, or forcing them to go to bed when they'd rather watch TV at night? How about keeping 15-year-olds locked out of pubs and arbitrarily forbidding them to operate a vehicle (severely restricting their freedom of movement in much of the US) against their will?

You can discuss the finer points of various restrictions, but there's nothing morally wrong with restricting someone with reduced mental capacity, below some basic level of competence, according to their mental capacity.

That's a false analogy. You have to bear in mind that the diagnosis of mental diseases has a fairly high failure rate and many behaviour that used to be classified as a mental disease has turned out to be perfectly fine.

That's your argument? That modern psychology and psychiatry is incapable of diagnosing debilitating conditions like schizophrenia in an individual living in a filthy tent-city - therefore we should err on the side of caution to such an extent that we cannot make a judgement call on anybody?

Of course we should err on the side of caution when deciding whether to lock someone against his will for an indefinite time into a psychiatric facility. What else did you think? Do you have any idea about the guidelines for psychiatric evaluation of such cases and their judicial oversight? Why the hurdles are set high? I don't believe you have, to be honest.

Maybe you start by thinking about how you would like to be treated if you happen to start suffering from schizophrenia, and then read up a bit on freedom and other fundamental human rights. Then you could read up on actual laws and the guidelines for psychiatric evaluations. Then at least you would have something to say.

> therefore we should err on the side of caution to such an extent that we cannot make a judgement call on anybody?

Well, I haven't said that, you're replying to a strawman. There is also no need to use an ominous "we". There are psychiatrists who make the judgement call under judicial oversight and their main criterion is, of course, whether the patient poses any imminent danger to himself or others. This is regulated by existing laws and procedures. Anything beyond that is illegal and, as I have argued, also immoral.

Overall, I have to say that some of the replies I've seen in this thread are far below the usual level of HN. It seems that some people have a personal vendetta against homeless people, or otherwise I can't explain that behaviour. At least, I seriously doubt that the same people would be willing to suggest that their mother or their wife should get locked up in a mental ward against their will if they happen to get ill from schizophrenia but nevertheless do not pose any danger to themselves or others - which was the premise of that discussion, mind you.

>Why the hurdles are set high? I don't believe you have, to be honest.

And I agree with that. Those standards should be high. The problem is that they seem to be so high as to make it impossible when looking at actual policies of West-coast municipalities.

>Well, I haven't said that, you're replying to a strawman.

I am really trying to understand what the standard is that you're advocating for because thus far it seems like it should never be the case that a homeless person with a mental illness is institutionalized.

>It seems that some people have a personal vendetta against homeless people, or otherwise I can't explain that behaviour.

That is an unfair assessment and you know it. The fundamental disagreement is that because we're talking about people who cannot make decisions because of debilitating mental illness some of us argue that therefore we should make certain decisions for them - one of which is, to provide them with care in a better setting than a tent-city. We're not talking about incarcerating or institutionalizing a 20-something that decides to live in a van.

Have you actually done any work with homeless? The face of homelessness is the face of drug addiction and/or debilitating mental illness. I suspect that there are people who still view homelessness in light of great depression where the homeless where those of sound mind simply seeking work, or run into some bad luck, and not have enough money to pay for housing. This is not the reality of homelessness in our society.

>At least, I seriously doubt that the same people would be willing to suggest that their mother or their wife should get locked up in a mental ward against their will if they happen to get ill from schizophrenia

Are you serious? It isn't even close. I would absolutely want my loved one to get the care they need instead of languishing in the streets. This isn't a choice between an individual living in a nice apartment with family and friends being around the corner to take care of their needs, and a government mental institution. This is a choice between being in a filthy, dangerous tent-city exposed to the elements or a government mental institution. It is a no-brainer. How could you think otherwise???!?!?

Maybe it is the specific handicap that you're objecting to. Maybe you think you can be a functional schizophrenic to the extent that you can choose to live in a tent-city in filth and therefore that right should be respected.

But what about others? What about someone suffering from Alzheimer's or dementia - when those people wind up homeless, is it OK to institutionalize them??? Or still not?

I'm really struggling to understand your standard here, because it's easy to say that every individual has a fundamental right not to be 'locked up' (as you put it), but then I don't know how you square that with realities on the ground that these people end up in atrocious circumstances.

Is it a more reliable predictor of mental incapacity than an arbitrary number of revolutions of a planet against a star, the one we use for driving, voting, drinking, and even straight up confinement as with schools?

> but there's nothing morally wrong with restricting someone with reduced mental capacity, below some basic level of competence, according to their mental capacity.

You state this like it's obvious, but it really isn't that obvious and there are severe problems with detention of people who don't pose a risk of hamr to themselves or others. And there's even problems if they only pose a risk of harm to themselves. The UK sees people banged up for years becuase they pose a risk of harm to themselves, when what they really need is better community treatment.

>You state this like it's obvious,

But it is. We do that all the time like, for example, during criminal proceedings. We understand that an individual with particular mental handicaps may not be fully (or at all) capable of making rational decisions and therefore should not bear the full responsibility for their actions.

>when what they really need is better community treatment.

What do you think 'community treatment' means!?!?!? You let them live in a filthy tent, with no clean water, no sanitation, no protection from the elements, with an occasional visit from a social worker to make sure they don't have cholera and have a blanket so they don't die from exposure?? That's your definition of 'community treatment'???

I'm pretty sure I would have been fine driving a car as soon as I could reach the pedals, and school was a waste of time after 5th grade; why did they restrict my freedom when in the latter case I'd at most harm myself? There were obvious and severe problems with that. Somehow we decided that after a certain age you can do whatever you want (more or less) and the constraints that arise from the fact that you are incapable, and dependent on care, stop applying. THAT is a completely arbitrary standard.

The only argument I can think in favor of this is that arbitrary age-based standard is much harder to abuse. But that is a (valid) implementation problem, not a moral one.

I don't buy the "incompatible with society" argument. It just sounds like an excuse not to help them. If you were in their shoes you would probably go crazy too.

Just yestersay some spanish tourists were asking me why were there so many homeless people in SF. I told them "America".

> I told them "America".

How w is this an A answer? It doesn't tell you anything about _Why_ there are so many homeless people.

American people will in general not fight for the man. They will fight against wellfare, healthcare, aids, etc

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